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array:24 [ "pii" => "S0025775315005862" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.09.021" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "3422" "copyright" => "Elsevier España, S.L.U.. Todos los derechos reservados" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2016;146:316-23" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 113 "formatos" => array:2 [ "HTML" => 91 "PDF" => 22 ] ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S2387020616302583" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.05.038" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "3422" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2016;146:316-23" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Inhaled therapy in asthma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "316" "paginaFinal" => "323" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia inhalada en el asma" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2410 "Ancho" => 3145 "Tamanyo" => 699157 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagnostic evaluation and treatment of adult asthma exacerbations. <span class="elsevierStyleItalic">Source</span>: Taken from the Spanish Guide for Asthma Management (GEMA) 4.0<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">11</span></a> and Rodrigo et al.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">41</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vicente Plaza Moral, Jordi Giner Donaire" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Vicente" "apellidos" => "Plaza Moral" ] 1 => array:2 [ "nombre" => "Jordi" "apellidos" => "Giner Donaire" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315005862" "doi" => "10.1016/j.medcli.2015.09.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315005862?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616302583?idApp=UINPBA00004N" "url" => "/23870206/0000014600000007/v1_201607151011/S2387020616302583/v1_201607151011/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S002577531500634X" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.11.012" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "3452" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2016;146:324-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 208 "formatos" => array:2 [ "HTML" => 147 "PDF" => 61 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnóstico y tratamiento</span>" "titulo" => "Nuevas terapias en el cáncer de tiroides" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "324" "paginaFinal" => "329" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "New therapies in thyroid cancer" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2817 "Ancho" => 1641 "Tamanyo" => 267472 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se define al paciente refractario a RAI como aquel que cumple alguna de las siguientes situaciones: A) Lesiones metastásicas que no capta RAI en el tratamiento inicial. B) El RAI se concentra en algunas lesiones, pero no en otras. C) Las lesiones pierden la capacidad para concentrar RAI después de una evidencia previa de enfermedad yodoávida. D) Lesiones que progresan en el último año a pesar de concentrar RAI. RAI: yodo radioactivo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro López Mondéjar, Juan Carlos Galofré" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "López Mondéjar" ] 1 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Galofré" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616302935" "doi" => "10.1016/j.medcle.2016.06.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616302935?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531500634X?idApp=UINPBA00004N" "url" => "/00257753/0000014600000007/v1_201603150321/S002577531500634X/v1_201603150321/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S002577531500648X" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.11.022" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "3464" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2016;146:311-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 23 "formatos" => array:2 [ "HTML" => 14 "PDF" => 9 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nota clínica</span>" "titulo" => "Expansión del triplete citosina-guanina-guanina: 3 casos de síndrome OMIM en una misma familia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "311" "paginaFinal" => "315" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Triplet expansion cytosine-guanine-guanine: Three cases of OMIM syndrome in the same family" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2300 "Ancho" => 3000 "Tamanyo" => 248322 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Árbol genealógico con los casos estudiados: familiares de primer, segundo y tercer grado a partir del caso índice/probando.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSmallCaps">IV</span>:6, IV:3 y IV:2: SXF; III:1, III:2; III:3: FXPOI; II:1: FXTAS; IV:4: mosaico premutado/mutado completo asintomático.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jesús González-Pérez, Silvia Izquierdo-Álvarez, Cristina Fuertes-Rodrigo, Lorena Monge-Galindo, José Luis Peña-Segura, Francisco Javier López-Pisón" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jesús" "apellidos" => "González-Pérez" ] 1 => array:2 [ "nombre" => "Silvia" "apellidos" => "Izquierdo-Álvarez" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Fuertes-Rodrigo" ] 3 => array:2 [ "nombre" => "Lorena" "apellidos" => "Monge-Galindo" ] 4 => array:2 [ "nombre" => "José Luis" "apellidos" => "Peña-Segura" ] 5 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "López-Pisón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616302625" "doi" => "10.1016/j.medcle.2016.05.042" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616302625?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531500648X?idApp=UINPBA00004N" "url" => "/00257753/0000014600000007/v1_201603150321/S002577531500648X/v1_201603150321/es/main.assets" ] "es" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Terapia inhalada en el asma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "316" "paginaFinal" => "323" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Vicente Plaza Moral, Jordi Giner Donaire" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Vicente" "apellidos" => "Plaza Moral" "email" => array:1 [ 0 => "vplaza@santpau.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Jordi" "apellidos" => "Giner Donaire" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Inhaled therapy in asthma" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1480 "Ancho" => 2711 "Tamanyo" => 227778 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Esquema de ayuda para la elección del inhalador.</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cámara inh: cámara de inhalación; DPI: <span class="elsevierStyleItalic">dry powder inhaler</span> («inhalador de polvo»); pMDI: <span class="elsevierStyleItalic">pressurized metered-dose inhaler</span> («cartucho presurizado de dosis medida»).</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">* El profesional sanitario implicará al paciente, según sus preferencias, en la elección final del dispositivo, entre los recomendados en dicho grupo.</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fuente: basada en parte en Broeders et al.<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">48</span></a>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introducción</span><p id="par0005" class="elsevierStylePara elsevierViewall">El principal inconveniente de la vía inhalada para la administración de fármacos estriba en la dificultad que la mayoría de los pacientes tienen para utilizarlos correctamente<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">1–3</span></a>. Un uso inapropiado de estos contribuye a un control deficiente tanto del asma<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">4</span></a> como de la EPOC<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">5</span></a>. Por tanto, los pacientes deben ser adiestrados en su correcto uso. Sin embargo, múltiples estudios recientes han mostrado que el nivel de conocimiento de los profesionales sanitarios sobre los aspectos teóricos y prácticos de la terapia inhalada es insuficiente<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">6,7</span></a>. Con el ánimo de paliar dichas carencias recientemente se editaron 2 documentos que el lector de la presente revisión debería consultar para una mayor información<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">8,9</span></a>. Por otro lado, y teniendo en consideración la aplicación de dicha terapia inhalada en el tratamiento del asma, que resume este documento, recientemente 2 importantes guías de práctica clínica para el asma, una internacional (GINA, 2015)<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">10</span></a> y otra nacional (GEMA 4.0, editada también en 2015)<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">11</span></a>, han actualizado sus enunciados con novedades relevantes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conceptos y fundamentos teóricos de los aerosoles</span><p id="par0010" class="elsevierStylePara elsevierViewall">Un «aerosol» es la suspensión de partículas microscópicas de material sólido o líquido en el aire u otro gas<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">9</span></a>. El tamaño de las partículas del aerosol se mide mediante el <span class="elsevierStyleItalic">diámetro de la mediana de la masa aerodinámica</span> (DMMA), que es el diámetro en el que la mitad de la masa de las partículas de un aerosol tiene un tamaño mayor, y la otra mitad, menor. La <span class="elsevierStyleItalic">masa respirable</span> de un aerosol es la cantidad de partículas con un diámetro inferior a 5<span class="elsevierStyleHsp" style=""></span>μm<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">9</span></a>. Las partículas de menor tamaño (0,5-2<span class="elsevierStyleHsp" style=""></span>μm) llegan a los bronquiolos terminales y la región alveolar, las de 2-5<span class="elsevierStyleHsp" style=""></span>μm se depositan en las pequeñas vías aéreas, las que tienen entre 5-10<span class="elsevierStyleHsp" style=""></span>μm, en las grandes vías aéreas, y las de tamaño superior a 10<span class="elsevierStyleHsp" style=""></span>μm, en el área orofaríngea<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">9</span></a>. El depósito de un fármaco depende de diversos factores<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">12–14</span></a>, entre los que destaca el papel del tamaño de la partícula. Según este, el aerosol se deposita por diferentes mecanismos: impactación o choque, sedimentación y difusión<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">12,13</span></a>.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Dispositivos</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Cartuchos presurizados de dosis medida</span><p id="par0015" class="elsevierStylePara elsevierViewall">Son conocidos por el acrónimo pMDI, del inglés <span class="elsevierStyleItalic">pressurized metered-dose inhaler</span>. En su interior el fármaco está disuelto o en suspensión en el propelente (gas vehiculizador), que al contactar con la presión atmosférica se transforma en gas (aerosol). Las principales ventajas de estos dispositivos son su portabilidad, la precisión de las dosis y el bajo coste; y las desventajas, la dificultad para realizar una maniobra de inhalación correcta (especialmente la coordinación entre la inspiración y la pulsación) y el elevado impacto orofaríngeo del fármaco<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">8,9,15</span></a>. Tipos (en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se resumen sus depósitos y DMMA):</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cartuchos presurizados de dosis medida convencionales.</span> Constan de una pequeña bombona o cartucho presurizado a 5<span class="elsevierStyleHsp" style=""></span>atm, de unos 10<span class="elsevierStyleHsp" style=""></span>ml, que contiene las partículas de fármaco en suspensión junto al propelente; una válvula dosificadora, que libera la dosis en ella depositada; y una carcasa de plástico externa, en la que se introduce el cartucho y sobre el que descansa la válvula de salida del aerosol. Los antiguos propelentes clorofluorocarbonos han sido sustituidos en la actualidad por los hidrofluoroalcanos<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">16</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cartuchos presurizados de dosis medida de partículas extrafinas</span> (Modulite<span class="elsevierStyleSup">®</span>). Se trata de un pMDI que contiene el fármaco en solución (por lo que no precisan agitarse)<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">13</span></a>. El orificio de salida de la válvula es de un tamaño menor que el de los pMDI convencionales, lo cual proporciona un aerosol con partículas más finas («extrafinas»), que se depositan en las pequeñas vías aéreas distales, suministrando un elevado depósito intrapulmonar<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">17,18</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cartuchos presurizados de dosis medida de autodisparo</span> (Autohaler<span class="elsevierStyleSup">®</span> y Easybreath<span class="elsevierStyleSup">®</span>). De diseño similar al pMDI convencional, pero se disparan automáticamente con la inspiración del paciente. No precisan coordinar la pulsación y la inspiración<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">19</span></a>.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inhalador de niebla fina</span> (Respimat<span class="elsevierStyleSup">®</span>). A medio camino entre un pMDI y un nebulizador de bolsillo. La solución atraviesa un filtro con 1.000 orificios (Uniblock<span class="elsevierStyleSup">®</span>), que divide y reconduce el aerosol al exterior en 2 columnas enfrentadas, que al colisionar genera una fina nube de aerosol<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">20</span></a>.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Cámaras de inhalación o espaciadores</span><p id="par0040" class="elsevierStylePara elsevierViewall">Aparato que se ajusta a los pMDI; al separar la boca de la salida del aerosol del pMDI, disminuye el impacto orofaríngeo de las partículas grandes<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">21,22</span></a>. Las principales ventajas es que hace innecesaria la coordinación entre la inspiración-pulsación y reduce los efectos secundarios locales; y entre los inconvenientes, su escasa portabilidad. Existe una gran variedad de cámaras disponibles, entre otras, con válvula unidireccional, colapsables o hinchables<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">9</span></a>.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Dispositivos de polvo inhalado</span><p id="par0045" class="elsevierStylePara elsevierViewall">Son conocidos como DPI, del inglés <span class="elsevierStyleItalic">dry powder inhaler</span>. Tienen en común que son pequeños, portátiles, no contienen gases propelentes y se liberan con la inspiración. El fármaco en polvo se encuentra en el dispositivo, ya sea aglomerado o, más frecuentemente, en combinación con partículas transportadoras (habitualmente lactosa). La presión inspiratoria y la turbulencia del flujo generada ocasionan la liberación de las partículas (aglomeradas o combinadas con un transportador). Entre sus ventajas destaca que no precisan coordinación entre inhalación y pulsación, la sencilla técnica de inhalación de los nuevos sistemas multidosis (habitualmente de solo 3 o 4 pasos) y su portabilidad; y entre sus inconvenientes, que precisan de una inspiración voluntaria y con flujos más altos que con los cartuchos presurizados de dosis medida<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">8,9,15</span></a>. Se pueden agrupar en 2 tipos o sistemas (en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se resumen sus depósitos y DMMA):</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sistemas unidosis</span> (por orden alfabético: Aerolizer<span class="elsevierStyleSup">®</span>, Breezhaler<span class="elsevierStyleSup">®</span>, Handihaler<span class="elsevierStyleSup">®</span>, Inhalator Ingelheim<span class="elsevierStyleSup">®</span>, Spinhaler<span class="elsevierStyleSup">®</span>). Dispositivos de una sola dosis. El medicamento se encuentra en el interior de una cápsula de gelatina dura que se introduce manualmente en el depósito del dispositivo<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">8,9</span></a>. Su principal inconveniente es que precisa de muchos pasos para su inhalación, lo cual puede ser fuente de errores en su manejo.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sistemas multidosis</span> (por orden alfabético: Accuhaler<span class="elsevierStyleSup">®</span>, Aerolizer<span class="elsevierStyleSup">®</span>, Easyhaler<span class="elsevierStyleSup">®</span>, Ellipta<span class="elsevierStyleSup">®</span>, Genuair<span class="elsevierStyleSup">®</span>, Handihaler<span class="elsevierStyleSup">®</span>, Nexthaler<span class="elsevierStyleSup">®</span>, Spiromax<span class="elsevierStyleSup">®</span>, Turbuhaler<span class="elsevierStyleSup">®</span> y Twisthaler<span class="elsevierStyleSup">®</span>). El fármaco, en polvo, se encuentra en un reservorio del que se retira mediante un sistema dosificador, o bien está precargado en alvéolos. Los más modernos disponen de algunas mejoras tecnológicas, entre otras, detectan si el paciente inhaló la dosis (Nexthaler<span class="elsevierStyleSup">®</span>), se bloquean tras la última dosis administrada (Genuair<span class="elsevierStyleSup">®</span>), la carga se realiza con solo abrir el dispositivo (Spiromax<span class="elsevierStyleSup">®</span>, Nexthaler<span class="elsevierStyleSup">®</span>, Ellipta<span class="elsevierStyleSup">®</span>, Twisthaler<span class="elsevierStyleSup">®</span>) o al accionar un pulsador (Easyhaler<span class="elsevierStyleSup">®</span>, Genuair<span class="elsevierStyleSup">®</span>), tienen retroinformación <span class="elsevierStyleItalic">(feedback)</span> visual y auditiva tras la inhalación (Nexthaler<span class="elsevierStyleSup">®</span> y Genuair<span class="elsevierStyleSup">®</span>)<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">15</span></a>. Pueden ser los preferidos por algunos pacientes<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">23</span></a> (ver el apartado «Educación y adiestramiento de las técnicas de inhalación» de esta revisión).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Nebulizadores</span><p id="par0060" class="elsevierStylePara elsevierViewall">Los nebulizadores generan una corriente de partículas de aerosol a partir de una solución en fase líquida. El aerosol se forma por la atomización de un líquido tras aplicarle determinada energía (gaseosa, eléctrica, etc.)<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">15,24</span></a>. Su principal ventaja reside en que no requieren la colaboración del enfermo y permiten administrar diferentes fármacos y combinaciones, de ahí que han tenido un profuso uso en la medicina de urgencias. Entre sus inconvenientes, que precisan tiempos prolongados de tratamiento y constituyen una fuente potencial de contaminación<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">9,13</span></a>. Tipos: <span class="elsevierStyleItalic">neumáticos</span> o <span class="elsevierStyleItalic">jet</span>, el aerosol se genera al proyectar un gas a alta presión sobre la solución; <span class="elsevierStyleItalic">ultrasónicos</span>, mediante un cristal piezoeléctrico que convierte la energía eléctrica en ondas ultrasónicas de alta frecuencia (superiores a 1<span class="elsevierStyleHsp" style=""></span>MHz); y de <span class="elsevierStyleItalic">malla fija o vibrante</span>, en los que la salida del aerosol se realiza a través de una malla con orificios de grosor predeterminado<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">25</span></a>.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Tratamiento inhalado del asma del adulto</span><p id="par0065" class="elsevierStylePara elsevierViewall">La mayoría de los fármacos a emplear utilizan la vía inhalatoria, quedando en la actualidad circunscritas tanto la vía oral (administración de glucocorticoides en la exacerbación) como la subcutánea (omalizumab en el asma alérgica grave no controlada, salbutamol en la exacerbación con riesgo vital) a indicaciones muy específicas, y prácticamente relegada la vía intravenosa.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Tratamiento de mantenimiento</span><p id="par0070" class="elsevierStylePara elsevierViewall">Los fármacos empleados en el tratamiento de mantenimiento del asma se aglutinan en 2 grandes grupos: medicamentos de control y medicamentos de alivio (o «de rescate»). Los de control, que deben administrarse a diario durante períodos prolongados, incluyen glucocorticoides inhalados (GCI) o sistémicos, antagonistas de los receptores de los leucotrienos (ARLT), <span class="elsevierStyleItalic">long-acting β</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">agonists</span> (LABA, «agonistas β<span class="elsevierStyleInf">2</span>adrenérgicos de acción larga»), tiotropio y anticuerpos monoclonales anti-IgE (omalizumab). Las cromonas y la teofilina de liberación retardada han caído en desuso por su menor eficacia. Los medicamentos de alivio se utilizan a demanda para tratar o prevenir la broncoconstricción de forma rápida, y entre ellos se encuentran los <span class="elsevierStyleItalic">short-acting β</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">agonists</span> (SABA, «agonistas β<span class="elsevierStyleInf">2</span>adrenérgicos de acción corta») inhalados (salbutamol o terbutalina) y los anticolinérgicos inhalados de acción corta (bromuro de ipratropio)<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">11</span></a>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">El tratamiento se ajusta en cada visita, con el objeto de que el paciente esté siempre controlado. Tras comprobar que el enfermo entiende y sigue las conductas de evitación de desencadenantes específicos (alérgenos) y no específicos (tabaquismo), su correcta adhesión al tratamiento y la técnica de inhalación apropiada de los inhaladores que está utilizando, se incrementará el tratamiento farmacológico de mantenimiento si su asma no estuviese bien controlada, o, por el contrario, se descenderá si hubiera estado bien controlada por lo menos en los 3 meses previos a la visita<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">26</span></a>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los tratamientos inhalados de elección recomendados en la última edición de la Guía Española para el Manejo del Asma (GEMA 4.0)<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">11</span></a> se distribuyen en los 6 escalones que muestra la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>, y los fármacos e inhaladores comercializados en nuestro ámbito (en julio de 2015) se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>. Brevemente:</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escalón 1.</span> SABA inhalados (salbutamol o terbutalina) a demanda ante síntomas aislados de asma. Los SABA inhalados administrados unos 10-15 min antes del ejercicio físico son los medicamentos de elección para prevenir la broncoconstricción inducida por ejercicio<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">27</span></a>.</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escalón 2.</span> GCI (beclometasona, budesónida, ciclesonida, fluticasona o mometasona) a dosis bajas y administrado diariamente. La dosis habitual oscila entre 200 y 400<span class="elsevierStyleHsp" style=""></span>μg/día de budesonida o equivalente<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">28</span></a>. En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se muestran las dosis equipotentes de los GCI recomendados<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">10,11</span></a>. Los GCI constituyen el tratamiento de mantenimiento para el asma persistente más efectivo tanto para controlar los síntomas diarios como para prevenir exacerbaciones<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">29,30</span></a>. En este escalón de asma leve la adición de un LABA a un GCI no aporta un beneficio relevante<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">31</span></a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escalón 3.</span> GCI a dosis bajas (ver <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>) junto con un LABA (salmeterol o formoterol o vilanterol) inhalados<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">32,33</span></a>, que preferiblemente se administran en un solo dispositivo. Las combinaciones comercializadas en España (en 2015) son: fluticasona propionato con salmeterol, budesónida con formoterol, beclometasona con formoterol, fluticasona propionato con formoterol, y fluticasona furoato con vilanterol. Los LABA nunca deben utilizarse en monoterapia. Formoterol es un LABA pero de inicio rápido, que combinado a dosis bajas de un GCI (budesónida o beclometasona) en un solo inhalador puede utilizarse tanto como tratamiento de mantenimiento como de alivio (estrategia conocida como MART, del inglés <span class="elsevierStyleItalic">maintenance and rescue therapy</span>) en pacientes con asma persistente moderada o grave (escalones 3 a 6)<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">34,35</span></a>.</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escalón 4.</span> GCI a dosis medias (ver <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>) junto con un LABA<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">32,36</span></a>, administrados en un solo inhalador. Como alternativa puede considerarse la combinación de un GCI a dosis medias, junto con un ARLT; no obstante, la adición de un LABA a un GCI proporciona mejores resultados<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">37</span></a>.</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escalón 5.</span> GCI a dosis altas (ver <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>) junto con un LABA<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">32,36</span></a>, administrados en un solo inhalador. En pacientes insuficientemente controlados con la anterior combinación y que tengan una obstrucción crónica del flujo aéreo se puede considerar la adición de tiotropio inhalado<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">38,39</span></a>.</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escalón 6.</span> No se recomiendan otros tratamientos inhalados específicos para los pacientes no controlados con los fármacos recomendados en el escalón anterior. En este supuesto se emplearán otras alternativas terapéuticas, como omalizumab subcutáneo, teofilina oral, termoplastia endobronquial y glucocorticoides parenterales<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">10,11,40</span></a>.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Tratamiento de la exacerbación</span><p id="par0115" class="elsevierStylePara elsevierViewall">Según la gravedad de la exacerbación asmática establecida de forma objetiva mediante pruebas de función pulmonar que determinen el grado de obstrucción (espirometría o flujo espiratorio máximo), las exacerbaciones se clasifican en leves, moderadas-graves o muy graves con riesgo vital y parada cardiorrespiratoria inminente<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">11,41</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>). La vía inhalada es la de elección para administrar el tratamiento en los 2 primeros supuestos.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Leve.</span> Los SABA (salbutamol o terbutalina) (ver dosis en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>) son los fármacos de primera elección, administrados preferiblemente con cámara de inhalación<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">42</span></a>. Se añadirán glucocorticoides sistémicos (por vía oral, preferiblemente) si: no se consigue una reversión de la obstrucción bronquial con SABA inhalados; el paciente ya estaba tomando glucocorticoides orales; se han probado otras opciones terapéuticas sin respuesta clínica favorable; o existen antecedentes de exacerbaciones graves<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">11,43</span></a>.</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Moderada-grave.</span> La administración de salbutamol y bromuro de ipratropio (dosis en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>), que se pueden combinar en la misma nebulización, se asocia a un incremento de la función pulmonar y a un descenso de las hospitalizaciones<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">44</span></a>. Los glucocorticoides sistémicos, administrados precozmente (en la primera hora) y preferiblemente por vía oral (dosis en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>), aceleran la resolución de la crisis y evitan las recidivas<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">45</span></a>. El uso precoz y solo durante las 2 primeras horas de dosis elevadas de GCI (dosis en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>) reduce los ingresos hospitalarios<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">45</span></a>. El sulfato de magnesio, inhalado u oral, en casos muy graves y sin respuesta al tratamiento anterior, reduce la necesidad de hospitalización<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">46</span></a>. El heliox (mezcla de oxígeno y helio) puede utilizarse para administrar medicación nebulizada<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">47</span></a>.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Aspectos prácticos</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Prescripción del inhalador y preferencias de los pacientes</span><p id="par0130" class="elsevierStylePara elsevierViewall">Diversos elementos pueden ser decisivos en la elección de un inhalador en el momento de la prescripción. En la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> se propone una aproximación racional, que combina algunos de ellos, para ayudar en la toma de la decisión<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">48</span></a>. Sin embargo, la adhesión al tratamiento y el control del asma es mayor cuando la prescripción del inhalador se establece de forma compartida entre el paciente y su médico<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">49</span></a>. Diversos estudios han mostrado que los dispositivos con técnicas de inhalación fáciles, con pocos pasos, son los preferidos por los enfermos<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">50–52</span></a>.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Educación y adiestramiento de las técnicas de inhalación</span><p id="par0135" class="elsevierStylePara elsevierViewall">El principal inconveniente de los inhaladores es que se debe enseñar a los pacientes a utilizarlos<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">3,53</span></a>, por lo que constituye uno de los elementos esenciales de los programas de educación de asma<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">10,11</span></a>, que además debe ser supervisada periódicamente<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">54</span></a>. En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se expone un propuesta<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">55</span></a> con los pasos a seguir en la visita inicial y en las de seguimiento.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Adhesión a los inhaladores</span><p id="par0140" class="elsevierStylePara elsevierViewall">Una baja adhesión a los inhaladores se asocia a un peor control del asma<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">56</span></a>, por lo que incrementar el cumplimiento terapéutico es un aspecto clave. Ello pasa por, en primer lugar, establecer el nivel de adhesión, y en segundo, iniciar una acción terapéutica específica. La simple anamnesis la sobrestima, por lo que se recomienda emplear la información obtenida tras la retirada de los fármacos en la farmacia (habitualmente en bases de datos electrónicos) y/o cuestionarios estandarizados cumplimentados por el propio paciente<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">10,11</span></a>. Recientemente se ha desarrollado un nuevo cuestionario específicamente diseñado para evaluar la adhesión de los pacientes con asma o con EPOC a los inhaladores, el Test de Adhesión a los Inhaladores (TAI)<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">57</span></a>. Este permite identificar al paciente con baja adherencia, establecer su intensidad (buena, intermedia o mala) y orientar el tipo o patrón de incumplimiento (errático, deliberado o inconsciente). La adhesión terapéutica mejora al establecer pautas fáciles, incorporar la opinión del paciente en la prescripción del inhalador, administrar un programa de educación y utilizar acciones específicas para los patrones de incumplimiento, por ejemplo, entrevista motivacional en el incumplidor «deliberado»<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">58</span></a> y recordatorios electrónicos o telemedicina en el «errático»<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">59</span></a>.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0145" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0150" class="elsevierStylePara elsevierViewall">La vía inhalada es la de elección para el tratamiento del asma.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0155" class="elsevierStylePara elsevierViewall">El tratamiento de mantenimiento del asma persistente leve (escalón 2) es un GCI a dosis bajas; el del asma persistente moderada (escalones 3 y 4), la combinación de un GCI a dosis bajas o medias con un LABA inhalados; y el del asma persistente grave (escalones 5 y 6), un GCI a dosis altas en combinación con un LABA.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0160" class="elsevierStylePara elsevierViewall">En las crisis asmáticas se recomienda el tratamiento con SABA inhalados. En las más graves se añadirá bromuro de ipratropio inhalado, GCI y glucocorticoides parenterales (orales, preferiblemente).</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0165" class="elsevierStylePara elsevierViewall">Debe adiestrarse a los pacientes en la técnica de inhalación. Sus preferencias se deben considerar en la elección del inhalador. Se debe establecer la adhesión a los inhaladores (entre otros, mediante el cuestionario TAI) e iniciar una acción terapéutica específica.</p></li></ul></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ningún conflicto de intereses.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres614978" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec628656" "titulo" => "Palabras clave" ] 2 => array:3 [ "identificador" => "xres614977" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec628655" "titulo" => "Keywords" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introducción" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Conceptos y fundamentos teóricos de los aerosoles" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Dispositivos" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Cartuchos presurizados de dosis medida" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Cámaras de inhalación o espaciadores" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Dispositivos de polvo inhalado" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Nebulizadores" ] ] ] 7 => array:3 [ "identificador" => "sec0040" "titulo" => "Tratamiento inhalado del asma del adulto" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Tratamiento de mantenimiento" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Tratamiento de la exacerbación" ] ] ] 8 => array:3 [ "identificador" => "sec0055" "titulo" => "Aspectos prácticos" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Prescripción del inhalador y preferencias de los pacientes" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Educación y adiestramiento de las técnicas de inhalación" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Adhesión a los inhaladores" ] ] ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conclusiones" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicto de intereses" ] 11 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-09-03" "fechaAceptado" => "2015-09-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec628656" "palabras" => array:2 [ 0 => "Asma" 1 => "Fármacos aerosolizados" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec628655" "palabras" => array:2 [ 0 => "Asthma" 1 => "Aerosolized drugs" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La administración de fármacos aerosolizados mediante la vía inhalada, dadas sus ventajas, constituye la vía de administración de elección para el tratamiento del asma y de la EPOC. El desarrollo tecnológico experimentado en las últimas décadas ha propiciado la aparición de múltiples inhaladores y fármacos aerosolizables. Tal variedad obliga al facultativo que los debe prescribir a conocerlos en profundidad. La presente revisión tiene como principal objetivo resumir el estado actual del conocimiento sobre inhaladores y fármacos inhalados habitualmente empleados en el tratamiento de mantenimiento y de la exacerbación del asma. El texto aborda desde aspectos teóricos (fundamentos, dispositivos y fármacos disponibles), a otros más prácticos y de relevancia en la asistencia clínica diaria del asma (pautas terapéuticas, educación y adhesión a los inhaladores).</p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Because of its advantages, inhaled administration of aerosolized drugs is the administration route of choice for the treatment of asthma and COPD. Numerous technological advances in the devices used in inhaled therapy in recent decades have boosted the appearance of multiple inhalers and aerosolized drugs. However, this variety also requires that the prescribing physician is aware of their characteristics. The main objective of the present review is to summarize the current state of knowledge on inhalers and inhaled drugs commonly used in the treatment of asthma. The review ranges from theoretical aspects (fundamentals and available devices and drugs) to practical and relevant aspects for asthma care in the clinical setting (therapeutic strategies, education, and adherence to inhalers).</p></span>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2035 "Ancho" => 3198 "Tamanyo" => 463745 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Escalones terapéuticos del tratamiento de mantenimiento del asma del adulto.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ARLT: antagonistas de los receptores de los leucotrienos; GCI: glucocorticoide inhalado; LABA: <span class="elsevierStyleItalic">long-acting β<span class="elsevierStyleInf">2</span> agonists</span> («agonista β<span class="elsevierStyleInf">2</span> adrenérgico de acción larga»).</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fuente: tomada de Guía Española para el Manejo del Asma (GEMA) 4.0<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">11</span></a>.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2491 "Ancho" => 3143 "Tamanyo" => 719553 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Evaluación diagnóstica y tratamiento de la exacerbación asmática del adulto.</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fuente: tomada de la Guía Española para el Manejo del Asma (GEMA) 4.0<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">11</span></a>.y Rodrigo et al.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">41</span></a>.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1480 "Ancho" => 2711 "Tamanyo" => 227778 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Esquema de ayuda para la elección del inhalador.</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cámara inh: cámara de inhalación; DPI: <span class="elsevierStyleItalic">dry powder inhaler</span> («inhalador de polvo»); pMDI: <span class="elsevierStyleItalic">pressurized metered-dose inhaler</span> («cartucho presurizado de dosis medida»).</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">* El profesional sanitario implicará al paciente, según sus preferencias, en la elección final del dispositivo, entre los recomendados en dicho grupo.</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fuente: basada en parte en Broeders et al.<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">48</span></a>.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Tabla 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Fuente: actualización del Consenso SEPAR-ALAT sobre terapia inhalada<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">9</span></a>." "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">DMMA: diámetro de la mediana de la masa aerodinámica; DPI: <span class="elsevierStyleItalic">dry powder inhaler</span> («inhalador de polvo»); pMDI: <span class="elsevierStyleItalic">pressurized metered-dose inhaler</span> («inhalador presurizado de dosis medida»).</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La comparación de los valores mostrados entre los diferentes dispositivos debe ser tomada con cautela, dados los diferentes métodos y fármacos empleados en su determinación, y en los estudios en humanos, por haberse realizado en diversas condiciones clínicas (sanos y enfermos con diferentes procesos y niveles de gravedad), flujos inspiratorios y edades.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Depósito pulmonar <span class="elsevierStyleSmallCaps">(%)</span></th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Depósito orofaríngeo <span class="elsevierStyleSmallCaps">(%)</span></th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleSmallCaps">DMMA (</span>μm)</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">In vivo</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">In vitro</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">In vivo</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">In vitro</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">pMDI</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pMDI convencional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7,8-34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53,9-82,2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1,4-8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pMDI convencional<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>cámara inhalación \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11,2-68,3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31,2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2-3,2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pMDI autodisparo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50-60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Modulite<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31-34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33-58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1-2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alvesco<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50-52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32,9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respimat<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40-53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19,3-39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">DPI (por orden alfabético)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Accuhaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12-37,1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15-30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3,5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Aerolizer<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13-28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21,7-28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1,9-7,9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Breezhaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2,8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Easyhaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18,5-31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Genuair<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30,1-34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54,7-61,9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Handihaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18-22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17,3-22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3,9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inhalator Ingelheim<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nexthaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1,4-1,5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spinhaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11,5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30,9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spiromax<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1,92-2,53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Turbuhaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14,2-38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53-71,6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57,3 69,3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1,7-5,4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Twisthaler<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36-37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2-2,2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1006908.png" ] ] ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Depósitos y diámetro de la mediana de la masa aerodinámica de los aerosoles proporcionados por los inhaladores</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Tabla 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Fuente: tomada de la Guía Española para el Manejo del Asma (GEMA) 4.0<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">11</span></a>." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dosis baja (μg/día) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dosis media (μg/día) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dosis alta (μg/día) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Beclometasona dipropionato \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200-500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">501-1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.001-2.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Beclometasona extrafina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100-200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">201-400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">><span class="elsevierStyleHsp" style=""></span>400 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Budesónida \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200-400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">401-800 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">801-1.600 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ciclesonida \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80-160 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">161-320 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">321-1.280 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fluticasona propionato \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100-250 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">251-500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">501-1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fluticasona furoato \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">184 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mometasona furoato \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100-200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">201-400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">401-800 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1006909.png" ] ] ] ] "descripcion" => array:1 [ "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Dosis equipotentes de los glucocorticoides inhalados ordenados por orden alfabético</p>" ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Tabla 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Fuente: actualización del Consenso SEPAR-ALAT sobre terapia inhalada<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">9</span></a>." "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">DPI: <span class="elsevierStyleItalic">dry powder inhaler</span> («inhalador de polvo»); GCI: glucocorticoide inhalado; INF: inhalador de niebla fina; LABA: <span class="elsevierStyleItalic">long-acting β</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">agonists</span> («agonista β<span class="elsevierStyleInf">2</span> adrenérgico de acción larga»); LAMA: <span class="elsevierStyleItalic">long-acting muscarinic antagonists</span> («antimuscarínico de acción larga»; pMDI: <span class="elsevierStyleItalic">pressurized metered-dose inhaler</span> («inhalador presurizado de dosis medida»); SABA: <span class="elsevierStyleItalic">short-acting β</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">agonists</span> («agonista β<span class="elsevierStyleInf">2</span> adrenérgico de acción corta»).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">μg/n.<span class="elsevierStyleSup">o</span> dosis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">SABA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Salbutamol</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ventolin<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Salbutamol Aldo-Unión<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Salbutamol Sandoz<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ventilastin (DPI)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ventoaldo<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Terbutalina</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Terbasmin<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">500/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">LABA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Formoterol</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Foradil<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oxis<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4,5/60; 9/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Broncoral<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12/50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Broncoral<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neblik<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Formoterol Stada<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Formoterol Aldo-Unión<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Salmeterol</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Serevent<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Betamican<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Inaspir<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Beglan<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Indacaterol</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ombrez<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oslif<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hirobriz<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Olodaterol</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Striverdi<span class="elsevierStyleSup">®</span> (INF) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2,5/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Glucocorticoide inhalado</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Budesonida</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pulmicort<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">400/120; 200/100; 100/100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pulmictan<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200/120; 100/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Olfex Bucal<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200/200; 50/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Budesonida Aldo-Unión<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200/100; 200/200; 50/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ribujet<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Budesonida Easyhaler<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100/200; 200/200; 400/100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Miflonide<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200; 400 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Novopulm<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200/200; 400/100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fluticasona</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Flixotide<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250/120; 50/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Inalacor<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250/120; 50/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Trialona<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250/120; 50/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Flusonal<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250/120; 50/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Beclometasona</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Beclo-asma<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250/200; 50/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Becotide<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Becloforte<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mometasona</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Asmanex<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">400/600 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ciclesonida</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Alvesco<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80/120; 160/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Glucocorticoide</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">LABA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Formoterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">budesonida</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Symbicort<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4,5/120; 160<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4,5/120; 320<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>9/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Rilast<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4,5/120; 160<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4,5/120; 320<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>9/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bufomix<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">160<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4,57120; 320<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>9/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Duoresp<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">160<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4,57120; 320<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>9/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Salmeterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">fluticasona</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Seretide<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>50/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>125/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>250/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Brisair<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>50/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>125/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>250/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Plusvent<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>50/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>125/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>250/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Anasma<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>50/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>125/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>250/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Inaladuo<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>50/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>125/120; 25<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>250/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Formoterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">beclometasona</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Foster<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>6/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Formodual<span class="elsevierStyleSup">®</span> (pMDI, DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>6/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Formoterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">fluticasona</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Flutiform<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>5/120; 125<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>5/120; 250<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>10/1205 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Vilanterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">fluticasona furoato</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Relvar<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>22/30; 184<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>22/30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Glucocorticoide inhalado</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">SABA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Salbutamol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">beclometasona</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Butosol<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>50/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Anticolinérgicos</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ipratropio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Atrovent<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Atroaldo<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20/200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tiotropio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Spiriva<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Spiriva<span class="elsevierStyleSup">®</span> (INF) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2,5/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Bromuro aclidinio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Eklira<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">322/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bretaris<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">322/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Bromuro glicopirronio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Seebri<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Enurev<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tovanor<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Umeclidinio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Incruse<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55/30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Cromonas</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nedocromil sódico</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tilad<span class="elsevierStyleSup">®</span> (pMDI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2<span class="elsevierStyleHsp" style=""></span>mg/112 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Glucocorticoide inhalado</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">SAMA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Formoterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ipratropio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Berodual<span class="elsevierStyleSup">®</span> HFA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50+20/120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">LABA</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">LAMA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Indacaterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">glicopirronio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ultibro<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85/43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ulunar<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85/43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Xoterna<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85/43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Vilanterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">umeclidinio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Anoro<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55/22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Formoterol</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aclidinio</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Duaklir Genuair<span class="elsevierStyleSup">®</span> (DPI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>340/60 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1006910.png" ] ] ] ] "descripcion" => array:1 [ "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Fármacos inhalados para el tratamiento del asma o de la enfermedad pulmonar obstructiva crónica comercializados en España en 2015</p>" ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Tabla 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Fuente: Horne<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">56</span></a>." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Visita inicial</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Realizar la sesión personalmente o delegarla en otro profesional sanitario con entrenamiento específico \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Explicar verbalmente la maniobra de inhalación y las razones de cada uno de los pasos \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Demostrar prácticamente la maniobra, describiendo cada paso \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Repetir la demostración sin explicación \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Repetir de nuevo la demostración con comentarios \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pedir al paciente que haga una demostración de la maniobra \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Explicar los defectos observados en la técnica del paciente \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Repetir la demostración y pedir al enfermo que repita la maniobra \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Citar al paciente para un futuro nuevo control de la técnica \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Visita de seguimiento</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Realizar la sesión personalmente o delegarla en un profesional sanitario con entrenamiento específico \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pedir al paciente que haga una demostración de la maniobra (sin explicaciones) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Explicar los defectos observados en la técnica del enfermo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Demostrar prácticamente la maniobra, describiendo cada paso, poniendo especial énfasis en los defectos observados \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Repetir la demostración sin explicación \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Repetir de nuevo la demostración con comentarios \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Citar al paciente para un futuro nuevo control de la técnica \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1006911.png" ] ] ] ] "descripcion" => array:1 [ "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Pasos recomendados para la educación-instrucción del paciente en la correcta técnica de inhalación del dispositivo, en la visita inicial y en las de seguimiento</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:59 [ 0 => array:3 [ "identificador" => "bib0300" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use and misuse of metered-dose inhalers by patients with chronic lung disease. A controlled, randomized trial of two instruction methods" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. De Blaquiere" 1 => "D.B. Christensen" 2 => "W.B. Carter" 3 => "T.R. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm/140.4.910" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1989" "volumen" => "140" "paginaInicial" => "910" "paginaFinal" => "916" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2679269" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0305" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of handling of inhaler devices in real life: An observational study in 3811 patients in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Molimard" 1 => "C. Raherison" 2 => "S. Lignot" 3 => "F. 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Sanchis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "1998" "volumen" => "65" "paginaInicial" => "195" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9670301" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0315" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Giraud" 1 => "N. Roche" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "246" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11866004" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0320" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaler mishandling is very common in patients with chronic airflow obstruction and long-term home nebuliser use" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Melani" 1 => "P. Canessa" 2 => "I. Coloretti" 3 => "G. DeAngelis" 4 => "R. 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